PAEDIATRICS

Question 1

What is SIRS?

Answer 1

Systemic inflammatory response syndrome - generalised inflammatory response defined by the presence of at least 2:

abnormal core temperature
abnormal HR
Raised RR
abnormal WCC

Question 2

What is Sepsis and what are it’s criteria?

Answer 2

Hypotension

Blood lactate >2mmol/L

Prolonged capillary refill >5 seconds

Pale/mottled or non-blanching (purpuric) rash

Oxygen needed to maintain saturations >92 %

RR >60 min-1 or >5 below normal, or grunting

§ AVPU = V, P or U Abnormal behaviour*

Question 3

What can indicate an emergency in an infant?

Answer 3

excessive dry nappies
lack of response to social cues
significantly dereased activity
weak
high pitched or continuous cry

Question 4

Define sepsis, severe sepsis, septic shock?

Answer 4

• SIRS in the presence of infection
• sepsis in the presence of CV dysfunction, respiratoyr distress syndrome or dysfunction of 2+ organs
• sepsis with CV dysfunction persisting after at least 40mL/kg of fluid resuscitation in one hour

Question 5

Organisms that cause sepsis?

Answer 5

Group B streptococcus
E. Coli
L. Monocytogenes
Staphlyococcus Epidermis (negative)
Staphylococcus Aureus and Pneumoniae (+ve)

Question 6

Investigations for sepsis?

Answer 6

clinical suspicion + bloods

Question 7

Management for Sepsis?

Answer 7

transfer to acute setting, 1 hrly observation
IV access
LP in < 1mnth, 1-3mnth who is unwell.
IV fluid resuscitation - 20mL
Bloods: clotting, culture, CRP, VBG, FBC, U+Es and creatinine.

Antibiotics within the hour
meningococcal
- benzylpenicillin (IM community)
- cefotaxime (IV hospital)